US Model Of Healthcare Flashcards
Why is the government unable to agree on costs in US Healthcare Model
Because of lobbying power from different parties
What parts of US Healthcare Model come from the Bismarck Model
Insurance for individuals under 65
What parts of US Healthcare Model come from Beveridge Model
Government provision and insurance/payment to provide free healthcare to Native Americans, military veterans, and active military
What parts of US Healthcare Model come from National Health Insurance Model
Medicare for those over 65
What parts of the US Healthcare Model come from the Out-of-Pocket Model
Many uninsured or insured who are responsible for high healthcare costs
What is Medicare
Federal health insurance for anyone over 65 and those under 65 with disabilities or specific conditions
What conditions could qualify someone for Medicare
End stage renal disease, cancer, COPD, etc.
What was Medicare designed to do
To cover hospital services and doctors’ services but not it also covers drugs, most preventative services, or nursing home care
What is not covered by Medicare
Hearing aids and eyeglasses
How is Medicare funded
By payroll tax from employees and employers
What does Part A of Medicare cover
Hospital care, skilled nursing care, and home health care after hospitalization-hospice care
What does Part B of Medicare cover
Wide range of diagnostic and therapeutic services provided by physicians, emergency departments, and outpatient services
How does Part B of Medicare work
It is a voluntary supplementary insurance from private insurers where patients must pay 20% of copayments with a $150/year deductible
What is Part C of Medicare
A special program to encourage Medicare beneficiaries to enroll in prepaid health plans
What is Part D of Medicare
Prescription drug coverage plan (requires patients to pay monthly premiums and annual deductibles)
What % of GDP does the US spend on their healthcare per year
18% ($9000/person/year)
What is Medicaid
A joint federal/state program designed to pay for health services for people with limited income and resources, etc.
How does coverage for Medicaid work
It is comprehensive but physician reimbursement is relatively low (not every physician chooses to participate)
What kinds of physicians often choose not to participate in Medicaid
Mental health, dental, dermatology, etc.
How many people does Medicaid currently cover
75 million (half of who are children)
How is Medicaid financed
Jointly by federal governments and states
How is Medicaid administered
By states within broad federal guidelines
How much does the Federal government pay for Medicaid
Variable amount from 5%-83% depending on the state’s per capita income
What is the Federal poverty level for a family of four
$25,000
What does employment-based health insurance look like in the US Healthcare Model
50% of all Americans hav option to purchase some form of insurance through employers
How did employment-based health insurance begin in the US
During WWII employers couldn’t raise wages so they offered healthcare benefits instead (fee for service payments/HMOs and capitation)
What are fee for service payments
Charges paid for specific services provided which encourages provision of many services (only works with “preferred providers”
What is capitation
Fixed number of dollars/month paid to physician to provide services to a patient regardless of the number of services provided
What does the health insurance exchange do
Provides way to get health insurance for those ineligible for other forms of comprehensive health insurance (like online marketplace for individuals, families, and small businesses)
What is the Affordable Care Act
Requires insurance to cover essential health benefits (dramatically reduced number of uninsured Americans to <10%)
What does the Affordable Care Act cover
Ambulatory patient services (outpatient services), emergency services, hospitalization, maternity and newborn care, mental health/SUD services, prescription drugs, rehab services, laboratory services, etc.
What are 4 programs to provide additional assistance to people injured or uninsured on the job under the Affordable Care Act
Worker’s compensation and federal programs for workers, social security disability insurance, and social security income
What are 6 reasons why being uninsured in the US is so problematic
They receive less preventative care, are diagnosed at more advanced stages of disease, receive less treatment once diagnosed, less likely to have usual source of healthcare, more likely to use emergency department for routine care, and increased mortality rate (~20,000 excess deaths/year)
